Saturday, September 1, 2012

Journal: writing prescriptions

Thismorning I have gone through the process of online submission of the first Case Study, which I wrote about in my most recent posting.  I found that I needed to restrict myself, as the word count was 2000-3000 words.  The additional material that I decided needed to be cut from the case study has mostly been pasted into my portfolio.

Today's task is to learn how to write prescriptions.  The list of medicines that are given for students to practice includes some drugs that I carry at present (such as lignocaine for perineal repair, and syntocinon to treat postpartum haemorrhage, and paediatric vitamin K), as well as narcotics oxycodone and panadeine forte, that I would seek to avoid. Antibiotics such as Amoxil and flucloxacillin may occasionally be useful.

My response to this assignment is complex, on several different levels.  While I am happy to upskill and have authorisation to prescribe medicines that are within my scope of practice, I feel conflicted as I am concerned that many midwives will prescribe just because they can.

One restriction that independent midwives have lived and worked under for as long as I can remember is that we have very little reliance on drugs.  Antibiotics, such as penicillin, are prescribed in many hospitals for any labouring woman who has tested positive to group B streptococcus (GBS).  In my practice, I do not swab for GBS, and I do not use antibiotics as a prophylaxis.  This is a safe practice, as long as there is no artificial rupture of the membranes, and as long as there are no internal examinations in early labour with ruptured membranes.  This practice is also safe because there is the stated intention to treat with antibiotics if symptoms of infection arise, particularly an unstable maternal temperature, with fetal tachycardia.

While every care plan focuses on avoidance of harm from the potentially catastrophic GBS infection, the plan to treat prophylactically is not without risk.  The use of antibiotics can lead to adverse effects in mother and baby, and long term morbidity. 

As an elder of the midwifery profession, I do not expect that my practice will change much, even when I have the right to prescribe from whatever formulary is available to midwives.  The PBS list is different from the NMBA list, which is different from the Victorian government's list (which has not yet been approved). 

I do hope younger midwives who move up in the ranks will hold to the basic knowledge of working in harmony with healthy natural processes in normal birth.  The principles of promoting, protecting, and supporting normal physiological processes are in the interests of mothers and babies, and are at the core of normal midwifery practice.

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